M. B. Chatterjee

Human resources for health in India

India has a severe shortage of human resources for health. It has a shortage of qualified health workers and the workforce is concentrated in urban areas. Bringing qualified health workers to rural, remote, and underserved areas is very challenging. Many Indians, especially those living in rural areas, receive care from unqualified providers. The migration of qualified allopathic doctors and nurses is substantial and further strains the system. Nurses do not have much authority or say within the health system, and the resources to train them are still inadequate. Little attention is paid during medical education to the medical and public health needs of the population, and the rapid privatisation of medical and nursing education has implications for its quality and governance. Such issues are a result of underinvestment in and poor governance of the health sector--two issues that the government urgently needs to address. A comprehensive national policy for human resources is needed to achieve universal health care in India. The public sector will need to redesign appropriate packages of monetary and non-monetary incentives to encourage qualified health workers to work in rural and remote areas. Such a policy might also encourage task-shifting and mainstreaming doctors and practitioners who practice traditional Indian medicine (ayurveda, yoga and naturopathy, unani, and siddha) and homoeopathy to work in these areas while adopting other innovative ways of augmenting human resources for health. At the same time, additional investments will be needed to improve the relevance, quantity, and quality of nursing, medical, and public health education in the country.

Assuring health coverage for all in India

Successive Governments of India have promised to transform Indias unsatisfactory health-care system, culminating in the present governments promise to expand health assurance for all. Despite substantial improvements in some health indicators in the past decade, India contributes disproportionately to the global burden of disease, with health indicators that compare unfavourably with other middle-income countries and Indias regional neighbours. Large health disparities between states, between rural and urban populations, and across social classes persist. A large proportion of the population is impoverished because of high out-of-pocket health-care expenditures and suffers the adverse consequences of poor quality of care. Here we make the case not only for more resources but for a radically new architecture for Indias health-care system. India needs to adopt an integrated national health-care system built around a strong public primary care system with a clearly articulated supportive role for the private and indigenous sectors. This system must address acute as well as chronic health-care needs, offer choice of care that is rational, accessible, and of good quality, support cashless service at point of delivery, and ensure accountability through governance by a robust regulatory framework. In the process, several major challenges will need to be confronted, most notably the very low levels of public expenditure; the poor regulation, rapid commercialisation of and corruption in health care; and the fragmentation of governance of health care. Most importantly, assuring universal health coverage will require the explicit acknowledgment, by government and civil society, of health care as a public good on par with education. Only a radical restructuring of the health-care system that promotes health equity and eliminates impoverishment due to out-of-pocket expenditures will assure health for all Indians by 2022--a fitting way to mark the 75th year of Indias independence.

Effect of fissility in fission time scales for 16,18O+194,198Pt systems

The pre-scission neutron multiplicities have been studied for 16,18O+194,198Pt at 50, 61, 71.7, 79 MeV excitation energy populating 210,212,214,216Rn compound nuclei having fissility 0.735, 0.732, 0.729, 0.726 respectively. Fission Time scales were extracted from the measured pre-scission neutron multiplicity and statistical model PACE2. The effect of fissility on fission time scales has been measured. It is found that fission time scales increases in a consistent way with fissility of the compound nuclei (CN) populated. The fission delays extracted for different CN are in good agreement with earlier published data for heavier systems [1, 2]. In the present work it is shown systematically that the fission time scales generally increases with fissility value of CN.

Pre‐fission neutron emission in 19F+209Bi reaction

The pre- and post-scission neutron multiplicities are measured for {sup 19}F+{sup 209}Bi reaction at E{sub lab} = 100, 104, 108, 112 and 116 MeV. The measured value of pre-scission neutron multiplicity was found to be increasing with the excitation energy. The comparison of experimental values with the statistical model calculations shows that the measured values are much larger than the model predictions. This difference in excess yield over the model predictions amounts to the survival time of 80{+-}5x10{sup -21} s for the {sup 228}U compound nucleus before it undergoes fission.

Entrance channel effects in fission of {sup 197}Tl

The pre- and post-scission neutron multiplicities are measured for {sup 16}O+{sup 181}Ta and {sup 19}F+{sup 178}Hf systems where the same compound nucleus {sup 197}Tl is formed at the same excitation energies (E*=72, 76, and 81 MeV). The measured pre-scission neutron multiplicities are found to be different for the two reactions and this difference in neutron yield increases with the excitation energy of the compound nucleus. The experimental pre-scission neutron yield is compared with predictions from the statistical model of compound nuclear decay containing the strength of nuclear viscosity as a free parameter. The magnitude of nuclear viscosity required to fit the experimental yield is found to be different for the two reactions. Because the two systems under consideration lie on the two sides of the Businaro-Gallone point, this observation indicates that the entrance channel mass asymmetry plays an important role in determining the number of neutrons emitted prior to scission in fusion-fission reactions.